主动脉弓复杂病变--HybridChimneyorelse

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1、主动脉弓复杂病变-HybridChimneyorelse Still waters run deep.流静水深流静水深,人静心深人静心深 Where there is life,there is hope。有生命必有希望。有生命必有希望u Endovascular Chimney Fenestration Branched Stent-graftCriado et al,J Endovasc Ther 2002累及主动脉弓病变可采用技术u Hybrid approach Cervical-thoracic Debranching Hybrid Procedures ResearchNo.Lan

2、ding ZoneZ0/Z1/Z2SuccessMortalityStrokeParaplegiaEndoleakHughes 20138748/19/0955.74.639Lotfi 20125148/19/0-1012616Vallejo 20123827/11/097.423.713.12.710.5Melissano 201214332/35/7690.94.92.8-8.4Ye 20124510/4/10/2197.86.76.7022.2Geisbusch 20114715/23/9-196.3614.9Guo 2010255/12/89842011Weruman 20092626

3、/0/01001540-Chaevel 2008165/8/3810190-杂交技术文献分析LandingzoneNo.ofpatientsPrimarytechnicalsuccessReinterventionsIn-hospitalmortalityInitialclinicalsuccessLatemortalityZone0130120（95.2%）12(12%)11（8.5%）111（88.1%）0Zone113170（83.3%）16(25.8%)6（4.6%）71（84.5%）2Total261190（90.5%）28（17.3%）17（6.5%）182（86.7%）2Pval

4、ue0.00690.03210.220.530.16Oddsratio42.551.931.35N/AKotelis D,et al.Total vs hemi-aortic arch transposition for hybrid aortic arch repair.J Vasc Surg.2011;54(4):1182-1186.Meta-analysisLandingzoneNo.ofpatientsStrokeSpinalcordinjuryTypeIendoleakTypeIIendoleakZone01304(3.2%)1(0.8%)5(4%)10(10%)Zone11315(

5、4.2%)3(2.3%)13(15.5%)8(12.9%)Total2619(3.7%)4(1.5%)18(8.6%)18(11.1%)Pvalue0.740.620.0050.61Oddsratio0.750.334.430.75Kotelis D,et al.Total vs hemi-aortic arch transposition for hybrid aortic arch repair.J Vasc Surg.2011;54(4):1182-1186.Meta-analysisIn-hospitalmortalityisrelativelylow(6.5%),neurologic

6、alcomplicationsnear5%.Endoleakrateisalsolow(8.6%fortypeI/III).Limitednumber,needlargevolumeandlong-termfollow-up主动脉弓杂交手术临床证据Chimney Technique 烟囱技术临床证据烟囱技术临床证据sourcesTechnical success Perioperative mortality(all-cause)Perioperative morbidityEndoleakStrokeLarzon et al,20051/2(50%)0/2(0%)0/2(0%)2/2(100

7、%)0/2(0%)Criado et al,20078/8(100%)0/8(0%)0/8(0%)0/8(0%)0/8(0%)Baldwin et al,20086/7(85.7%)0/7(0%)1/7(14.1%)2/7(28.5%)1/7(14.2%)Ohrlander,et al,20083/4(75%)0/4(0%)1/4(25%)2/4(50%)1/4(25%)Sugiura,et al,20099/11(81.8%)2/11(18.1%)a3/11(27.2%)2/11(18.2%)1/11(9.1)Cires et al,20119/9(100%)1/9(11/1%)2/9(22

8、.2%)1/9(11.1%)1/9(11.1%)Yoshida et al,20112/2(100%)0/2(0%)0/2(0%)0/2(0%)0/2(0%)Sue et al,20118/8(100%)0/8(0%)0/8(0%)2/8(25%)0/8(0%)No.ofpatients(vessels)Landingzone(Z0/Z1/Z2)Technical successStrokeIEndoleakChimneygraftspatentcy94(101)20/48/3398%5.3%18%100%Hogendoornw,etalThoracicendovascularaorticre

9、pairwiththechimneygrafttechnique.JVascSurg.2013:May19,S0741-745.Meta-analysisofclinicaloutcomeswithchimney烟囱技术临床证据Overallperioperativemortality(3.2%)Morbidityrate(strokerate5.3%)Graftpatency(100%)Allcomparabletohybridseries.Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique

10、.JVascSurg.2013:May19,S0741-745.Allthechimneystentswereofflabeluse,thesamplenumbersmall,mostlessthan10cases.Relativenew,withamedianfollow-upof11months与杂交手术证据相比，烟囱技术问题1Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2013:May19,S0741-745.Inchimneyseris,nearly1/3i

11、nZone2,thetypeIendoleakratewas18%1.ThehigherrateofendoleakswhentheBCAorLCCAarestentedcomparedwiththeLSAonly(30%and27%vs9.1%).与杂交手术证据相比，烟囱技术问题Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2013:May19,S0741-745.JVasSurg.2013,June:57(6):1664-67LioupisC,etal.EuroJ

12、VasEndovasSurg.2012,May,525-32TAA Involving LSA and LCCA Fenestration in situWith home-made endo-shuntsCuttingBalloonFenestration in situ of LCCA and LSAConclusionslHybrid procedure well proved and could be used in most cases at present time.lChimney grafts should only be used in specific cases(eg.high surgical risk,Zone 2).lFenestration and branched grafts need further investigation.Thanks Thanks for your attentionfor your attention